PROJECTSUMMARY Weproposetotesttheimplementationofevidence-basedpreventiveinterventionsthroughaVirtualLearning Collaborative(VLC)withandwithoutthenoveluseAutomatedSurveillanceReporting(ASR)interventionto changeclinicalpracticeandimprovepatientsafetyincommondiagnosticprocedures.Over2millionpeoplein theUnitedStatesundergodiagnosticorinterventionalcardiaccatheterizationeachyear.Acutekidneyinjury (AKI),apatientsafetymetricsetbytheNationalQualityForum,occursinupto14%ofallpatientsfollowinga procedureandupto50%inpatientswithpre-existingchronickidneydisease(CKD),makingAKIthemost prevalentadverseevent.PatientsdevelopingAKIhaveanincreasedriskofseriousadverseevents.Thereare widelyacceptedinterventionstopreventAKIinpatientsundergoingcardiaccatheterization.Ourresearchteam hasdemonstratedAKIcanbepreventedin28%ofpatientswithCKDthroughalargeregionalpilot.Ourteam hasalreadydevelopedASRtechniquesforAKInationallywithintheVeterans?Administration.Basedonour ownpreliminarystudies,wehypothesizetheincorporationofanautomatedplug-inASRtoolkittoprovidenear- realtimefeedbacktofront-linecareteamswillsignificantlyaugmentbothVLCandTechnicalAssistance(TA) interventionsinimplementationtrials.Ourobjectiveistoconductanationalrandomizedclinicaltrialtestingthe useofVLCorTAwithorwithoutaplug-inASRtoolkittodetermineifASRsignificantlyimprovesoutcomesfor patientsundergoingprocedureswithcontrastdyetoovercometheinconsistentapplicationofknownwaysto preventAKI.TherationaleunderlyingtheprojectisthatASRcouldprovetobeaplug-invehicletoimprove patientendpointsinevidence-basedpreventiveinterventionsincommondiagnosticprocedures.Weplanto testourhypothesisthroughthefollowingspecificaimsina2x2factorialcluster-randomizedtrial.Forallaims, 16hospitalswillberandomizedtoreceiveoneofthefollowinginterventionsfor18-months:A)Technical Assistance(TA);?B)TechnicalAssistancewithAutomatedSurveillanceReporting(TA+ASR);?C)Virtual LearningCollaborative(VLC)withteam-basedcoaching(VLC);?andD)VirtualLearningCollaborativewith AutomatedSurveillanceReporting(VLC+ASR).SpecificAim1:ComparetheefficacyofaVLCand/orASR comparedtoTAtoreducetheincidenceofAKI.SpecificAim2:EvaluatethesustainedefficacyofVLCand/or ASRtoreducetheincidenceofAKIfollowingtheinterventionperiod.Theinterventionsproposedusenovel interactivevideocoachingsessionsandASRaslow-costscalableimplementationstrategiestopreventa clinicalendpoint(AKI).Eighteenhospitalshaveagreedtoparticipateandberandomized.Weexpectthe impactofaplug-inASRtoaugmentevidencebasedpreventiveinterventionsandVLCcouldsignificantly improvetheconsistentapplicationoftheseinterventionsandimplementationtrials.Inouropinion,ourstudy willopenthedoortoanewparadigmofimplementationscienceseekingtocontinuouslyimprovehealthcare.